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Cigna TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna TotalCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna TotalCare (HMO D-SNP) in 2025, please refer to our full plan details page.
Cigna TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in South Florida. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Cigna TotalCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Cigna TotalCare (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Cigna TotalCare (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Cigna TotalCare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Cigna TotalCare (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, the plan's premium may be reduced. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Cigna TotalCare (HMO D-SNP) plan offers a variety of benefits with varying cost structures. Inpatient hospital stays have a copay of $150 for the first 5 days, and then no copay for the following days. Outpatient services and emergency services have copays that range from $0 to $150. This plan includes coverage for primary care, preventive services, hearing, vision, and dental services. Many services, such as primary care, vision exams, and routine dental, have no copay. Other services, like ambulance, medical equipment, and diagnostic services, are covered with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits for the Cigna TotalCare (HMO D-SNP) plan include coverage for both acute and psychiatric inpatient hospital stays. For days 1-5 of an inpatient stay, there is a $150 copay, and for days 6-90, there is no copay. Additional days for inpatient hospital-acute are covered. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, as well as additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a copay between $0 and $150, Observation Services have a $150 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services are covered with a waived three-pint deductible. Individual and Group Sessions for Outpatient Substance Abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna TotalCare (HMO D-SNP) plan, with a copay of $85. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna TotalCare (HMO D-SNP) plan. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 40 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Cigna TotalCare (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services has a $20 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services are covered with no coinsurance, while Chiropractic Services, Mental Health Specialty Services, Psychiatric Services, and Additional Telehealth Benefits are covered, but require a doctor referral and/or prior authorization; however, Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services are not covered. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, health education, kidney disease education, and other preventive services such as glaucoma screenings, and barium enemas, with coverage for services not usually covered by Medicare plans. Some services, including in-home safety assessments, personal emergency response systems, and weight management programs, are not covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, with a limit of one visit per year for each. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, with a limit of two visits per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are over-the-counter hearing aids.
Vision Services See details
The Cigna TotalCare (HMO D-SNP) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum benefit of $200 per year. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. This plan also covers orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. There is a $3,500 annual maximum for other dental services, and prior authorization is required for Medicare dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Cigna TotalCare (HMO D-SNP), but require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment is covered, with Durable Medical Equipment (DME) and Prosthetic Devices subject to a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts are also subject to a 20% coinsurance. Medical Supplies have a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Cigna TotalCare (HMO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare (HMO D-SNP) plan, with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna TotalCare (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Cigna TotalCare (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $90.00 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage. Other services, including acupuncture, are not covered.
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